RADICAL CHEMORADIOTHERAPY FOR ELDERLY PATIENTS WITH BLADDER-CARCINOMAINVADING MUSCLE

BACKGROUND, Chemoradiotherapy is becoming an alternative to radical cy stectomy among patients with bladder carcinoma invading muscle. In 198 8, the authors began a protocol with methotrexate, vinblastine, doxoru bicin, and cisplatin (M-VAC regimen) and radiotherapy for these patien ts. Traditionally, age has been considered a determinant factor thereb y excluding the older patients from the oncologic protocols that are c onsidered to be more aggressive. The authors analyzed 20 patients (age > 70 years) who were treated during this period with the same protoco l as the authors' other patients. METHODS, The study included 20 patie nts (age range, 70-78 years; median age, 74 years) including 4 patient s with T2 disease, 9 with T3 disease, and 7 with T4 disease. All patie nts had a Karnofsky performance status of > 60. Treatment protocol inc luded cytoreductive transurethral resection, 2 cycles of M-VAC chemoth erapy, and radiotherapy (45 grays [Gy] on pelvic volume) with concurre nt cisplatin (20 mg/m(2) on Days 1-5. Response was determined by cysto scopic evaluation. If there was a complete response, radiotherapy cont inued until a total dose of 65 Gy; if there was not a complete respons e, cystectomy was performed.RESULTS, Tumor response after a dose of 45 Gy included 11 complete responses (55%), 5 partial responses (25%), a nd 4 nonresponses (20%). Overall survival was 75%, 34%, and 27% in the 2nd, 3rd, and 5th years of follow-up, respectively. Cause specific su rvival was 79%, 54%, and 38%, respectively. Survival for patients with complete response was 100%, 60%, and 48%, respectively. Severe toxici ty was uncommon, with the most frequent toxicities being leukopenia an d cystitis. No treatment-related death occurred with either treatment protocol. CONCLUSIONS, The age of the individual must not become a str ict exclusion criterion for the radical treatment of old patients with invasive bladder carcinoma. (C) 1997 American Cancer Society.